Provider Demographics
NPI:1770540650
Name:SNYDER, DAVID LUIS (OD)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:LUIS
Last Name:SNYDER
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:250 S ORANGE DR
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90036-3011
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:22 S CHAPEL AVE
Practice Address - Street 2:
Practice Address - City:ALHAMBRA
Practice Address - State:CA
Practice Address - Zip Code:91801-3948
Practice Address - Country:US
Practice Address - Phone:626-282-8493
Practice Address - Fax:626-282-1910
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-26
Last Update Date:2011-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOPT 5208 TPA152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASD0052081Medicaid
CASD0052081Medicaid